636 MULTI-INSTITUTIONAL ANALYSIS OF ROBOTIC PARTIAL NEPHRECTOMY FOR HILAR VS NON-HILAR LESIONS IN 282 CONSECUTIVE CASES

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 2010636 MULTI-INSTITUTIONAL ANALYSIS OF ROBOTIC PARTIAL NEPHRECTOMY FOR HILAR VS NON-HILAR LESIONS IN 282 CONSECUTIVE CASES Lori M. Dulabon, Jihad H. Kaouk, Georges-Pascal Haber, Firas Petros, Craig G. Rogers, and Michael D. Stifelman Lori M. DulabonLori M. Dulabon New York, NY More articles by this author , Jihad H. KaoukJihad H. Kaouk Cleveland, OH More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Firas PetrosFiras Petros Detroit, MI More articles by this author , Craig G. RogersCraig G. Rogers Detroit, MI More articles by this author , and Michael D. StifelmanMichael D. Stifelman New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.972AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal hilar tumors pose additional challenges to the laparoscopic surgeon. Robotic assistance may facilitate removal of these challenging renal lesions. In order to evaluate this, we analyzed the outcomes of our robotic-assisted partial nephrectomy (RPN) series for hilar renal tumors and compared them to non-hilar renal tumors in a multi-institutional collaborative study. METHODS After IRB approval, we reviewed 282 consecutive patients who underwent RPN at 3 institutions over a 40 month time period (June 2006-Oct 2009). Data was collected in a prospective fashion. Renal hilar lesion was defined as a renal tumor originating on the medial aspect of the kidney, abutting the renal artery/vein, and/or renal pelvis with involvement of the renal sinus. Patients were stratified into hilar lesions and non hilar lesions. We compared demographic, operative and post-operative outcomes of these two groups. Student-t and Fischer's exact tests were used for statistical analysis with a p-value < 0.05 considered significant. RESULTS Twenty seven patients had a hilar renal mass and 255 patients had non-hilar lesions. Data is summarized in Tables 1 and 2. There were no statistical differences in patient demographics except for larger tumor size in the hilar cohort. (3.36±1.3cm vs 2.89±1.5cm; p = 0.033). The only significant difference in operative outcomes was a slight increase in warm-ischemia times (WIT) for the hilar group (24.3 min vs 20.0 min; p = 0.038). There were no differences in post-operative outcomes, except for a trend for increased risk of malignancy and higher staged tumors in the hilar tumor cohort. Table 1. Demographics. Demographics Characteristic Hilar Tumors (n = 27) Non-Hilar Tumors (n = 255) Mean Age, years, (SD) 61.4(12.4) 61.1(11.5) ASA Score (SD) 2.36(0.81) 2.41(0.61) BMI, kg/m2, (SD) 29.1(6.8) 30.0(6.3) Gender Males 20(74%) 155(61%) Females 7(26%) 100(39%) Max Tumor Size, cm (range) 3.36±1.3(1.2-7.0)⁎ 2.40±0.6(0.7-8.5) ⁎ p = <0.05 Table 2. Operative and Peri-Operative Outcomes. Operative Outcomes Characteristic Hilar Tumors (n = 27) Non-Hilar Tumors (n = 255) Operative Time Minutes, (SD) 208(56) 210(61) Warm Ischemia Time, min. (SD) 24.3(7.0) 20.0(10.3)⁎ Estimated Blood Loss, mL (SD) 215(228) 227(223) Intra-Operative Conversion Rate (%) 0(0%) 8(3%) Robotic RN 0 3(1%) Conventional Laparosocpic PN 0 4(1.5%) Hand-Assisted Laparoscopic PN 0 1(0.4%) Post-Operative Outcomes Characteristic Hilar Tumors (n=27) Non-Hilar Tumors (n=255) Length of Stay, Days (SD) 2.9(1.8) 3.0(1.6) Peri-Op Transfusion Rate 7.40% 8.10% Malignancy Identified 24(88%) 184(72%) Stage T1a 18(75%) 155(84%) T1b 1(4%) 24(13%) T2 1(4%) 0(0%) T3a 3(12.5%) 5(2.7%) T3b 1(4%) 0 N/A 3 71 Positive Margins 0(0%) 5(2%) Post-Op Complications 1(3%) 9(3.5%) Pseudoaneurysm 1(3%) 5(1.9%) Urinoma 0 4(1.6%) ⁎ p = <0.05 CONCLUSIONS This data represents the largest series of its kind, and strongly suggests that RPN is a safe, effective, and feasible option for the minimally-invasive approach to renal hilar tumors w